Contributions
Abstract: P589
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
The Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) group recently proposed new dissemination in space (DIS) criteria that include lesions in the optic nerve, cortex and symptomatic region, in addition to an increase in the required number of periventricular (PV) lesion from 1 to 3. We aim to compare the diagnostic performance of the 2010 McDonald and 2016 MAGNIMS magnetic resonance imaging (MRI) criteria for DIS in predicting the conversion to clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndromes (CIS).
Inclusion criteria:
1) CIS suggestive of central nervous system demyelination (since 2008);
2) clinical assessment and baseline brain MRI within 6 months of CIS onset;
3) spinal cord MRI available if patients presented with spinal cord syndrome; and
4) clinical follow-up of at least 24 months.
We included 161 CIS patients, 113 (70.2%) women, with a mean age at onset of 34 years. After a mean follow-up of 58 months, 102 (63.4%) patients were diagnosed as having MS according to the McDonald 2010 criteria. The overall conversion rate to CDMS was 48.4%. Forty-six (45%) patients initiated a disease-modifying treatment (DMT) before the second clinical event. The 2010 McDonald DIS criteria were met in 100 (62.1%) and the 2016 MAGNIMS DIS criteria in 95 (59%) patients with CIS. Six patients with 1 PV lesion fulfilled the 2010 McDonald criteria but did not the 2016 MAGNIMS criteria. In contrast, when symptomatic infratentorial/spinal cord lesions were included, two more patients met the 2016 DIS criteria than the 2010 McDonald criteria. The sensitivity, specificity, and positive and negative predictive values of 2010 McDonald criteria were 80.7%, 55.4%, 63% and 75.4%, and those for 2016 MAGNIMS criteria were 75.6%, 56.6%, 62.1, and 71.2%, respectively. Both DIS criteria identified a subset of patients with CIS who were at high early risk of developing CDMS (hazard ratio: 2.17, p< 0.001; and 2.07, p< 0.002; respectively).
In our CIS patient cohort, 2016 MAGNIMS MRI criteria for DIS showed lower sensitivity with similar specificity than 2010 McDonald criteria in predicting conversion to CDMS, probably related to the increase in the required number of PV lesions. Because DMT can delay or prevent the conversion to CDMS, the high number of patients that initiated these therapies before the second relapse, would explain the intermediate specificity values obtained with both MRI criteria.
Disclosure: Raquel Lamas Pérez: nothing to disclose. María Díaz Sánchez: nothing to disclose. Pablo Baena Palomino: nothing to disclose. Lucía Lebrato Hernández: nothing to disclose. José Luis Casado Chocán: nothing to disclose. Antonio José Uclés Sánchez: nothing to disclose.
Abstract: P589
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
The Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) group recently proposed new dissemination in space (DIS) criteria that include lesions in the optic nerve, cortex and symptomatic region, in addition to an increase in the required number of periventricular (PV) lesion from 1 to 3. We aim to compare the diagnostic performance of the 2010 McDonald and 2016 MAGNIMS magnetic resonance imaging (MRI) criteria for DIS in predicting the conversion to clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndromes (CIS).
Inclusion criteria:
1) CIS suggestive of central nervous system demyelination (since 2008);
2) clinical assessment and baseline brain MRI within 6 months of CIS onset;
3) spinal cord MRI available if patients presented with spinal cord syndrome; and
4) clinical follow-up of at least 24 months.
We included 161 CIS patients, 113 (70.2%) women, with a mean age at onset of 34 years. After a mean follow-up of 58 months, 102 (63.4%) patients were diagnosed as having MS according to the McDonald 2010 criteria. The overall conversion rate to CDMS was 48.4%. Forty-six (45%) patients initiated a disease-modifying treatment (DMT) before the second clinical event. The 2010 McDonald DIS criteria were met in 100 (62.1%) and the 2016 MAGNIMS DIS criteria in 95 (59%) patients with CIS. Six patients with 1 PV lesion fulfilled the 2010 McDonald criteria but did not the 2016 MAGNIMS criteria. In contrast, when symptomatic infratentorial/spinal cord lesions were included, two more patients met the 2016 DIS criteria than the 2010 McDonald criteria. The sensitivity, specificity, and positive and negative predictive values of 2010 McDonald criteria were 80.7%, 55.4%, 63% and 75.4%, and those for 2016 MAGNIMS criteria were 75.6%, 56.6%, 62.1, and 71.2%, respectively. Both DIS criteria identified a subset of patients with CIS who were at high early risk of developing CDMS (hazard ratio: 2.17, p< 0.001; and 2.07, p< 0.002; respectively).
In our CIS patient cohort, 2016 MAGNIMS MRI criteria for DIS showed lower sensitivity with similar specificity than 2010 McDonald criteria in predicting conversion to CDMS, probably related to the increase in the required number of PV lesions. Because DMT can delay or prevent the conversion to CDMS, the high number of patients that initiated these therapies before the second relapse, would explain the intermediate specificity values obtained with both MRI criteria.
Disclosure: Raquel Lamas Pérez: nothing to disclose. María Díaz Sánchez: nothing to disclose. Pablo Baena Palomino: nothing to disclose. Lucía Lebrato Hernández: nothing to disclose. José Luis Casado Chocán: nothing to disclose. Antonio José Uclés Sánchez: nothing to disclose.